Provider Demographics
NPI:1114093168
Name:HARMON, DAVID JEROME (DO)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JEROME
Last Name:HARMON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 WADE HAMPTON BLVD # B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-1152
Mailing Address - Country:US
Mailing Address - Phone:864-268-4335
Mailing Address - Fax:864-268-3868
Practice Address - Street 1:2720 WADE HAMPTON BLVD # B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-1152
Practice Address - Country:US
Practice Address - Phone:864-268-4335
Practice Address - Fax:864-268-3868
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC227156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC45027OtherVI CARE GROUP
SC110809OtherEYEMED VISION
SCA9302OtherMEDCOST
SC0610380001Medicare ID - Type UnspecifiedEXAMS AND GLASSES